|
CPAP or BiPAP Setup (first day)
|
$838.40 |
$838.40 |
$838.40 |
$584.50
|
|
CPR (Cardiopulmonary Resuscitation)
|
$830.40 |
$830.40 |
$830.40 |
$777.71
|
|
Critical care each additional 30 minutes
|
$456.80 |
$456.80 |
$456.80 |
$686.86
|
|
Critical Care (first 30 to 74 minutes)
|
$1,664.00 |
$1,664.00 |
$1,664.00 |
$2,535.00
|
|
CT 3d report other modality w/workstation
|
$1,083.20 |
$1,083.20 |
$1,083.20 |
$661.13
|
|
Cta lower extremity without & w/contrast (both sides)
|
$2,401.60 |
$2,401.60 |
$2,401.60 |
$1,986.77
|
|
CT Angiogram of Abdomen and Pelvis
|
$4,371.20 |
$4,371.20 |
$4,371.20 |
$2,839.85
|
|
CT Angiogram of the Abdomen
|
$3,770.40 |
$3,770.40 |
$3,770.40 |
$1,994.52
|
|
CT Angiogram of the Abdomen and Both Legs
|
$3,770.40 |
$3,770.40 |
$3,770.40 |
$1,909.90
|
|
CT Angiogram of the Chest (for blood clot)
|
$2,789.71 |
$2,789.71 |
$2,789.71 |
$1,915.30
|
|
CT Angiogram of the Head
|
$3,183.20 |
$3,183.20 |
$3,183.20 |
$1,940.00
|
|
CT Angiogram of the Neck
|
$3,183.20 |
$3,183.20 |
$3,183.20 |
$1,881.75
|
|
CT angio pelvis
|
$2,588.80 |
$2,588.80 |
$2,588.80 |
$1,806.60
|
|
Cta upper extremity w &/or without contrast left
|
$2,422.40 |
$2,422.40 |
$2,422.40 |
$1,691.30
|
|
CT guidance for needle placement
|
$1,712.80 |
$1,712.80 |
$1,712.80 |
$1,494.00
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$1,365.60 |
$1,365.60 |
$1,365.60 |
$1,215.06
|
|
CT heart w/evaluation of calcium without contrast
|
$231.20 |
$231.20 |
$231.20 |
$150.00
|
|
CT limited or localized follow-up study
|
$963.20 |
$963.20 |
$963.20 |
$636.55
|
|
CT lwr extremity w/o&w/dye
|
$2,388.80 |
$2,388.80 |
$2,388.80 |
$1,818.96
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$4,371.20 |
$4,371.20 |
$4,371.20 |
$3,426.52
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$4,127.64 |
$4,127.64 |
$4,127.64 |
$2,871.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,623.76 |
$3,623.76 |
$3,623.76 |
$2,272.00
|
|
CT t-spine w /wo contrast
|
$2,641.60 |
$2,641.60 |
$2,641.60 |
$1,975.00
|
|
CT uppr extremity w/o&w/dye
|
$2,377.60 |
$2,377.60 |
$2,377.60 |
$1,845.36
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$62.38 |
$62.38 |
$62.38 |
$25.32
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$894.19 |
$894.19 |
$894.19 |
$1,305.02
|
|
Cyclophosphamide 25 mg capsule
|
$16.25 |
$16.25 |
$16.25 |
$19.49
|
|
Cystogram >= 3 views supervision & interpretation
|
$552.00 |
$552.00 |
$552.00 |
$586.95
|
|
Cytarabine 20 mg/ml injection solution
|
$171.16 |
$171.16 |
$171.16 |
$90.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$215.20 |
$215.20 |
$215.20 |
$159.90
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$137.60 |
$137.60 |
$137.60 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$133.60 |
$133.60 |
$133.60 |
$87.45
|
|
Cytopathology concentration technique smears & interpretation
|
$192.80 |
$192.80 |
$192.80 |
$135.20
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$172.00 |
$172.00 |
$172.00 |
$127.50
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$112.00 |
$112.00 |
$112.00 |
$68.06
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$339.20 |
$339.20 |
$339.20 |
$191.66
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$274.40 |
$274.40 |
$274.40 |
$213.85
|
|
Cytopath smear other source
|
$137.60 |
$137.60 |
$137.60 |
$92.50
|
|
Cytopath tbs c/v manual
|
$77.60 |
$77.60 |
$77.60 |
$59.28
|
|
Dacarbazine 100 mg intravenous solution
|
$196.53 |
$196.53 |
$196.53 |
$62.41
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$85.94 |
$85.94 |
$85.94 |
$171.19
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$15,510.40 |
$15,510.40 |
$15,510.40 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$2,524.80 |
$2,524.80 |
$2,524.80 |
$6,281.29
|
|
Darbepoetin alfa, esrd use
|
$2,524.80 |
$2,524.80 |
$2,524.80 |
$7.20
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$692.00 |
$692.00 |
$692.00 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$176.80 |
$176.80 |
$176.80 |
$284.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$463.20 |
$463.20 |
$463.20 |
$835.20
|
|
Debride nail1-5 11720
|
$112.00 |
$112.00 |
$112.00 |
$149.60
|
|
Debride nail6 or more 11721
|
$161.60 |
$161.60 |
$161.60 |
$169.80
|
|
Debrid/rmv fgn bdy/open fx/skin/sq 11010
|
$2,094.40 |
$2,094.40 |
$2,094.40 |
$1,149.50
|
|
Debr musc/fascia 20sq cm/< 11043
|
$884.80 |
$884.80 |
$884.80 |
$1,165.50
|
|
Decalcification
|
$96.80 |
$96.80 |
$96.80 |
$68.34
|
|
Decitabine 50 mg intravenous solution
|
$4,363.94 |
$4,363.94 |
$4,363.94 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$207.20 |
$207.20 |
$207.20 |
$572.95
|
|
Deferoxamine 500 mg solution for injection
|
$90.65 |
$90.65 |
$90.65 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$1,855.50 |
$1,855.50 |
$1,855.50 |
$1,856.85
|
|
Demonstrate use home inr mon
|
$246.40 |
$246.40 |
$246.40 |
$294.75
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$164.00 |
$164.00 |
$164.00 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$4,977.12 |
$4,977.12 |
$4,977.12 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$351.20 |
$351.20 |
$351.20 |
$401.60
|
|
Design mlc device for imrt
|
$3,862.40 |
$3,862.40 |
$3,862.40 |
$1,753.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$63.99 |
$63.99 |
$63.99 |
$91.84
|
|
Device ablt adv novasure
|
$760.80 |
$760.80 |
$760.80 |
$6,237.48
|
|
Device intraute mirena
|
$933.07 |
$933.07 |
$933.07 |
$2,125.00
|
|
Device sut capio slim opn
|
$1,622.40 |
$1,622.40 |
$1,622.40 |
$1,860.95
|
|
Device tiss remov myosure reach
|
$2,060.80 |
$2,060.80 |
$2,060.80 |
$2,515.00
|
|
Dexamethasone 4 mg tablet
|
$53.86 |
$53.86 |
$53.86 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$61.75 |
$61.75 |
$61.75 |
$20.76
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$875.14 |
$875.14 |
$875.14 |
$884.80
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$75.59 |
$75.59 |
$75.59 |
$36.05
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$75.59 |
$75.59 |
$75.59 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$75.59 |
$75.59 |
$75.59 |
$48.00
|
|
Diab manage trn ind/group
|
$32.00 |
$32.00 |
$32.00 |
$54.99
|
|
Diagnostic anoscopy spx 46600
|
$212.80 |
$212.80 |
$212.80 |
$195.50
|
|
Diagnostic laryngoscopy 31575
|
$878.40 |
$878.40 |
$878.40 |
$338.00
|
|
Diagnostic Mammogram (both breasts)
|
$424.00 |
$424.00 |
$424.00 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$382.40 |
$382.40 |
$382.40 |
$314.00
|
|
Diagnostic radio unlisted proc
|
$951.20 |
$951.20 |
$951.20 |
$259.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$68.84 |
$68.84 |
$68.84 |
$79.71
|
|
Diffusing capacity
|
$308.00 |
$308.00 |
$308.00 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$62.28 |
$62.28 |
$62.28 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$7,158.74 |
$7,158.74 |
$7,158.74 |
$10,279.62
|
|
Diltiazem 5 mg/ml intravenous solution
|
$61.23 |
$61.23 |
$61.23 |
$45.60
|
|
Dimecaprol injection
|
$293.38 |
$293.38 |
$293.38 |
$314.63
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$1.20 |
$1.20 |
$1.20 |
$1.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$60.44 |
$60.44 |
$60.44 |
$18.32
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$193.23 |
$193.23 |
$193.23 |
$95.06
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$692.80 |
$692.80 |
$692.80 |
$949.39
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$304.23 |
$304.23 |
$304.23 |
$65.40
|
|
Doppler echo complete
|
$1,022.40 |
$1,022.40 |
$1,022.40 |
$558.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$840.80 |
$840.80 |
$840.80 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$1,043.20 |
$1,043.20 |
$1,043.20 |
$481.65
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$213.40 |
$213.40 |
$213.40 |
$450.14
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$4,100.80 |
$4,100.80 |
$4,100.80 |
$1,718.24
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$72.39 |
$72.39 |
$72.39 |
$89.34
|
|
Drainage external ear simple 69000
|
$789.60 |
$789.60 |
$789.60 |
$790.40
|
|
Drain blood from under nail 11740
|
$172.80 |
$172.80 |
$172.80 |
$182.40
|
|
Drain cerebro spinal fluid 62272
|
$384.00 |
$384.00 |
$384.00 |
$1,044.00
|
|
Drain finger abscess;simple 26010
|
$415.20 |
$415.20 |
$415.20 |
$428.40
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$383.20 |
$383.20 |
$383.20 |
$397.65
|